Provider Demographics
NPI:1992759971
Name:WILLIAMS, ANDREA M (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8334 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:SUITE 103-151
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3774
Mailing Address - Country:US
Mailing Address - Phone:704-544-6533
Mailing Address - Fax:704-544-6583
Practice Address - Street 1:7006 SHANNON WILLOW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1318
Practice Address - Country:US
Practice Address - Phone:704-544-6533
Practice Address - Fax:704-544-6583
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22182207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134F5Medicaid
SCGP4146Medicaid
SCGP4146Medicaid
G88616Medicare UPIN
NC89134F5Medicaid